Skip to main content
PMC home page
Canadian Family Physician logoLink to Canadian Family Physician
. 2004 Oct;50:1388–1394.

Women marginalized by poverty and violence. How patient-physician relationships can help.

Susan Woolhouse 1, Judith Belle Brown 1, Barbara Lent 1
PMCID: PMC2214511  PMID: 15526876

Abstract

OBJECTIVE: To explore the experiences of women relegated to the margins of society by poverty or violence. DESIGN: Qualitative method of focus groups. SETTING: Shelters and transitional housing in southwestern Ontario. PARTICIPANTS: Thirty-six women staying at shelters or transitional housing. METHOD: Focus groups conducted at five locations explored the women's experiences and interactions with family physicians. MAIN FINDINGS: Two themes emerged from the analysis: power imbalances in patient-physician relationships, and the role of family physicians in creating collaborative relationships. Women who felt demeaned in patient-physician relationships described their family physicians as dominating and intimidating. Women who described relationships as collaborative felt valued and understood. CONCLUSION: Poor or abused women living in shelters who felt powerless in patient-physician relationships felt even more demeaned as they coped with the struggles associated with being poor. Women who had continuous collaborative relationships with their family physicians were able to articulate their needs more readily.

Full Text

The Full Text of this article is available as a PDF (199.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Band P. R., Gallagher R. P., Threlfall W. J., Hislop T. G., Deschamps M., Smith J. Rate of death from cervical cancer among native Indian women in British Columbia. CMAJ. 1992 Dec 15;147(12):1802–1804. [PMC free article] [PubMed] [Google Scholar]
  2. Bassuk E. L., Dawson R., Perloff J., Weinreb L. Post-traumatic stress disorder in extremely poor women: implications for health care clinicians. J Am Med Womens Assoc. 2001 Spring;56(2):79–85. [PubMed] [Google Scholar]
  3. Brown J. B., Sas G. Focus groups in family practice research: an example study of family physicians' approach to wife abuse. Fam Pract Res J. 1994 Mar;14(1):19–28. [PubMed] [Google Scholar]
  4. Burg M. A. Health problems of sheltered homeless women and their dependent children. Health Soc Work. 1994 May;19(2):125–131. doi: 10.1093/hsw/19.2.125. [DOI] [PubMed] [Google Scholar]
  5. Cohen M. Impact of poverty on women's health. Can Fam Physician. 1994 May;40:949–958. [PMC free article] [PubMed] [Google Scholar]
  6. Forrest C. B., Starfield B. Entry into primary care and continuity: the effects of access. Am J Public Health. 1998 Sep;88(9):1330–1336. doi: 10.2105/ajph.88.9.1330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goodman L., Saxe L., Harvey M. Homelessness as psychological trauma. Broadening perspectives. Am Psychol. 1991 Nov;46(11):1219–1225. doi: 10.1037//0003-066x.46.11.1219. [DOI] [PubMed] [Google Scholar]
  8. Hwang S. W., Bugeja A. L. Barriers to appropriate diabetes management among homeless people in Toronto. CMAJ. 2000 Jul 25;163(2):161–165. [PMC free article] [PubMed] [Google Scholar]
  9. Hwang S. W. Homelessness and health. CMAJ. 2001 Jan 23;164(2):229–233. [PMC free article] [PubMed] [Google Scholar]
  10. Lipman E. L., Offord D. R., Boyle M. H. Single mothers in Ontario: sociodemographic, physical and mental health characteristics. CMAJ. 1997 Mar 1;156(5):639–645. [PMC free article] [PubMed] [Google Scholar]
  11. Malterud K. Strategies for empowering women's voices in the medical culture. Health Care Women Int. 1993 Jul-Aug;14(4):365–373. doi: 10.1080/07399339309516062. [DOI] [PubMed] [Google Scholar]
  12. McCauley J., Kern D. E., Kolodner K., Derogatis L. R., Bass E. B. Relation of low-severity violence to women's health. J Gen Intern Med. 1998 Oct;13(10):687–691. doi: 10.1046/j.1525-1497.1998.00205.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Pappas G., Queen S., Hadden W., Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. doi: 10.1056/NEJM199307083290207. [DOI] [PubMed] [Google Scholar]
  14. Plichta S. B., Duncan M. M., Plichta L. Spouse abuse, patient-physician communication, and patient satisfaction. Am J Prev Med. 1996 Sep-Oct;12(5):297–303. [PubMed] [Google Scholar]
  15. Shennan A. T. Factors in low birth weight. CMAJ. 1997 Dec 15;157(12):1737–1739. [PMC free article] [PubMed] [Google Scholar]
  16. Sweeney K. G., Gray D. P. Patients who do not receive continuity of care from their general practitioner--are they a vulnerable group? Br J Gen Pract. 1995 Mar;45(392):133–135. [PMC free article] [PubMed] [Google Scholar]
  17. Usatine R. P., Gelberg L., Smith M. H., Lesser J. Health care for the homeless: a family medicine perspective. Am Fam Physician. 1994 Jan;49(1):139–146. [PubMed] [Google Scholar]
  18. Watson W. J., Wetzel W., Devanesen S. Working with Inner-City Families: An ecological approach for the family physician. Can Fam Physician. 1991 Dec;37:2585–2592. [PMC free article] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES